Dadian N, Ohki T, Veith F J, Edelman M, Mehta M, Lipsitz E C, Suggs W D, Wain R A
Division of Vascular Surgery Montefiore Medical Center - Albert Einstein College of Medicine, New York, New York, USA.
J Vasc Surg. 2001 Dec;34(6):986-96. doi: 10.1067/mva.2001.119241.
The purpose of this study was to analyze the incidence, severity, and etiologic factors of the development of colon ischemia after endovascular aortoiliac aneurysm repair (EVAR).
During the last 9 years we performed 278 elective EVARs using a variety of grafts. To facilitate these repairs, one hypogastric artery (HA) was coil embolized in 109 patients and both HAs were coil embolized in 13 patients. The preprocedural status of the inferior mesenteric, hypogastric, and iliac arteries as well as anatomical characteristics of the abdominal aortic aneurysm were determined arteriographically and by computerized tomographic scans. Postoperative colon ischemia was documented by colonoscopy or operative findings.
Colon ischemia occurred in eight patients (2.9%). Three patients with colon ischemia died and had evidence of widespread (cutaneous, renal, small bowel, and/or lower extremity) microembolization. One of these three had a colectomy and microscopic emboli were present. One other patient who required a colectomy also had pathologic evidence of colonic microembolization but survived. Four other patients with colon ischemia were treated conservatively and survived. In one patient, previous colectomy with interruption of mesenteric collaterals may have been a contributory cause of colon ischemia. Of the eight patients with colon ischemia, only one had unilateral HA occlusion, and none had bilateral HA occlusion. The other 121 patients with unilateral and bilateral HA occlusion had no evidence of colon ischemia.
Colon ischemia occurs after EVAR with an incidence approximating that of open repair. Colon ischemia was unrelated to HA interruption. Embolization appears to be a major cause of colon ischemia, although inadequate mesenteric collateral circulation may also play an etiologic role. Mortality with colon ischemia accompanied by widespread embolization was high, whereas colon ischemia without it was often mild and amenable to nonoperative management.
本研究旨在分析血管腔内腹主动脉瘤修复术（EVAR）后结肠缺血的发生率、严重程度及病因。
在过去9年中，我们使用多种移植物进行了278例择期EVAR手术。为便于这些修复，109例患者的一支髂内动脉（HA）被弹簧圈栓塞，13例患者的两支HA均被弹簧圈栓塞。通过动脉造影和计算机断层扫描确定肠系膜下动脉、髂内动脉及腹主动脉瘤的术前状态以及解剖特征。术后结肠缺血通过结肠镜检查或手术发现记录。
8例患者（2.9%）发生结肠缺血。3例结肠缺血患者死亡，并有广泛（皮肤、肾脏、小肠和/或下肢）微栓塞的证据。这3例中的1例接受了结肠切除术，显微镜下可见微栓子。另1例需要结肠切除术的患者也有结肠微栓塞的病理证据，但存活下来。其他4例结肠缺血患者接受保守治疗并存活。1例患者先前接受过结肠切除术，肠系膜侧支循环中断可能是结肠缺血的一个促成因素。在8例结肠缺血患者中，只有1例有单侧HA闭塞，无一例有双侧HA闭塞。其他121例单侧和双侧HA闭塞患者无结肠缺血证据。
EVAR术后发生结肠缺血，其发生率与开放修复术相近。结肠缺血与HA中断无关。栓塞似乎是结肠缺血的主要原因，尽管肠系膜侧支循环不足也可能起病因作用。伴有广泛栓塞的结肠缺血死亡率很高，而无广泛栓塞的结肠缺血通常较轻，适合非手术治疗。
